Surgery coordinator,Insurance Medical, precertification,authorization

TERRY L CRAIG

Skills

Precertification/Imaging Claims Process/Authorization/Inpatient/Outpatient procedures

Insurance Specialization

Diagnosis codes specialist

ICD10-CPT codes CABG, AVR, MVR

Medical Billing & Coding

Medical Records

HIPAA Knowledge

Professional Experience

Savannah Vascular and Cardiac Institute

Savannah, GA

Surgical Coordinator

10/19/2015 to 03/01/2017

Effectively and efficiently distribute new patient referrals to physician and medical staff

Schedule returning patients to appropriate physician, schedule patient surgeries

Checks new patient referral numbers for managed care plans, current insurance data, and identification

Documents new patient referral data

Assembles all medical information related to the patient for the purpose of creating the medical chart

Obtains patient medical records from referring physicians and ensures the records are reviewed before the patient is seen

Determines pre-certifications for surgeries

Explains surgical consent and gives instruction for preoperative process

Audits work regularly to determine that patients have been scheduled with the appropriate physician

Cardiac and Vascular Institute

Gainesville, FL

Precertification/Authorizations/Verification Insurance

06/07/2012 to 07/25/2015

Responsible for obtaining authorizations for testing and procedures

Review patient records and verify the proper CPT codes and diagnosis codes

Maintain all websites used for the authorization process

Document all verbal and printed authorizations and ensure all authorizations are obtained

AvMed Health Plans

Gainesville, FL

Provider Data Professional

1999 to 03/12

Responsible for building and updating all provider contractual agreements, and demographical information for the provider network in all geographic regions

Built and maintained the code set alignments that enable member assignment, claims payment, accurate Web and paper directories

Resolves provider issues for pending claims and maintains configuration for EDI claims submission for Hospital, Hospital based physicians, Primary Care Physicians, Specialty Care Physicians and other Healthcare Professions

Assisted with Federal/State statue reporting, accreditation audits and 1099 submissions and performs front end triage on provider request for assistance

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